Single posterior implant-supported restorations fabricated using a scannable healing abutment versus a conventional scan body: A randomized controlled trial.

STATEMENT OF PROBLEM: The use of a scannable healing abutment is a convenient option for fabricating implant-supported restorations (ISRs) with a digital workflow; however, clinical studies evaluating prosthetic efficacy are lacking. PURPOSE: The purpose of this randomized controlled trial was to investigate the prosthetic efficacy of definitive posterior single ISRs fabricated after scanning using a scannable healing abutment-scan peg (SHA-SP) in comparison with a conventional scan body (CSB). The time for data acquisition, quality of proximal and occlusal contacts, and relative occlusal force of ISRs were measured. MATERIAL AND METHODS: Twenty-four participants eligible for single ISRs to replace the mandibular first molar with adjacent and antagonist teeth present were randomly allocated to either a study group (n=12) receiving ISRs after intraoral scanning using an SHA-SP or a control group (n=12) receiving ISRs after intraoral scanning using CSB. During the surgical procedure, a prefabricated contoured scannable healing abutment was screwed to the implant in the SHA-SP group, while a custom-made healing abutment was used in the CSB group. After a healing period of 3 months, an intraoral scan was made, and the duration of data acquisition was recorded. The ISRs were milled from zirconia and evaluated for the quality of proximal and occlusal contacts using dental floss and shim stock, respectively. The relative occlusal forces of the ISRs and their contralateral natural teeth were measured using a digital occlusal analyzer. Statistical analysis was done using an independent sample t test for quantitative variables and a Pearson chi-squared test for qualitative variables between the tested groups (α=.05). RESULTS: The direct digital workflow using SHA-SP was statistically less time consuming than the CSB (P<.001). The 2 groups were statistically similar regarding the quality of the proximal contacts (P=.281) or occlusal contacts (P=.307) and the relative occlusal forces of ISRs (P=.315). The relative occlusal forces of the ISRs in both groups were significantly lower than those of their contralateral natural teeth (P<.001). CONCLUSIONS: Direct digital workflow using SHA-SP was more rapid, saving clinical chairside time, and produced proximal and occlusal contacts of comparable quality with those obtained with CSB. The relative occlusal forces of ISRs in both workflows were lower than their contralateral natural teeth.

Piezosurgical Buccal Plate Repositioning Technique: A Modified Surgical Approach for the Horizontal Augmentation of Atrophied Mandibles.

PURPOSE: To demonstrate a modified surgical approach for horizontal ridge augmentation that allows for safe manipulation and predictable management of the buccal plate and avoids creation of a secondary surgical site. MATERIALS AND METHODS: This pilot randomized controlled clinical trial included 24 patients who required horizontal alveolar ridge augmentation. Patients were assigned to one of the three groups: Group A was treated with the buccal plate repositioning (BPR) technique and grafted with silica calcium phosphate nanocomposite (SCPC) graft, group B was similarly managed and grafted using demineralized freeze-dried bone allograft (DFDBA), and group C was augmented using mandibular ramus autogenous bone block graft (ABBG). The primary outcome was the coronal crest width, which was measured at 6 months using CBCT. RESULTS: The BPR technique resulted in horizontal augmentation with a mean of 4.30 ± 0.94 mm for group A, showing no significant difference from either group B (4.98 ± 1.13 mm) or group C (3.68 ± 0.27 mm). All augmented ridges allowed for successful implant placement with good primary stability. CONCLUSIONS: The BPR technique resulted in horizontal bone gain in extremely narrow alveolar ridges. It allowed for implant placement in a vascular cancellous bed protected by intact cortical plate. Different types of bone grafts, whether alloplast or allograft, resulted in successful augmentation comparable to that gained from autogenous block grafting.

Vitamin C mesotherapy versus diode laser for the esthetic management of physiologic gingival hyperpigmentation: a randomized clinical trial.

BACKGROUND: Physiologic gingival hyperpigmentation is a common esthetic concern that affects individuals of various ethnicities, and can have a significant impact on individual's self-confidence and overall quality of life. Thus, this study aimed to clinically assess the effectiveness of intra-mucosal injection of vitamin C versus 980 nm diode laser for the management of physiologic gingival hyperpigmentation. METHODS: Twenty-six healthy non-smoker individuals with physiologic gingival hyperpigmentation were randomly assigned to two groups. Group I received intra-mucosal injection of vitamin C (L-Ascorbic acid 1000 mg/5 ml), and group II was managed using diode laser (980 nm, 1.5 W, continuous wave mode). Clinical evaluation of pigmentation intensity and distribution was performed preoperatively, and at 1, 2 and 3 months postoperatively using two different color assessment indices; Dummett-Gupta Oral Pigmentation Index (DOPI), and Gingival Pigmentation Index (GPI). Additionally, the study assessed pain intensity and patients' satisfaction. RESULTS: Pigmentation scores decreased significantly between pre-operative visit and different follow-up visits for both treatment modalities (p < 0.0001*). When compared to the vitamin C mesotherapy group, the laser group demonstrated significantly lower gingival pigmentation scores (p < 0.0001*). However, both treatment modalities were equally satisfying for the patients. CONCLUSIONS: Vitamin C mesotherapy and diode laser are both effective in the management of physiologic gingival hyperpigmentation. While diode laser yields better and earlier results, vitamin C mesotherapy offers a cost-effective, safe and minimally invasive approach that is equally satisfying for the patients seeking esthetic enhancements. TRIAL REGISTRATION: The study was registered on ClinicalTrials.gov (NCT05608057) on (01/11/2022).

Positional transfer accuracy of titanium base implant abutment provided by two different scan body designs: an invitro study.

BACKGROUND: The variabilities in design and material of scan bodies have a major role in the positional transfer accuracy of implants. The purpose of this invitro study was to compare the 3D transfer accuracy (trueness and precision) of titanium base (TB) abutment position provided by 2 different scan bodies: one-piece scan body (SB) in comparison to two-piece healing abutment and scan peg (HA-SP). METHODS: A maxillary model with a dummy implant in the 2nd premolar (Proactive Tapered Implant; Neoss) was 3D printed and TB (Ti Neolink Mono; Neoss) was tightened on the implant and scanned by using a laboratory scanner (inEos X5; Dentsply Sirona) (reference scan). An SB (Elos Medtech) and an HA-SP (Neoss) were subsequently connected to the implant and were scanned 10 times each by using the same scanner (test scans). All the scans were exported as STL files and imported into CAD software where the TBs were formed. Test scans were superimposed on reference scans for transfer accuracy analysis using 3D metrology software (GOM Inspect; GOM GmbH) in terms of angular deviation in vertical and horizontal directions, linear deviation in each XYZ axis of TBs and total linear deviation in all axes. Statistical analysis was done using independent sample t test. When Levene's test for equality of variances was significant, Welch's t-test was used. (P value < 0.05) RESULTS: Significant differences were found amongst the tested groups in both angular and linear deviation in terms of trueness with less deviation values for the SB group (P < 0.001). For the precision, significant differences were found amongst the tested groups in angular deviation in vertical direction with less deviation value for the SB group compared to HA-SP group (P < 0.001). However, no significant difference was found between the tested groups regarding the angular deviation in horizontal direction (P = 1.000). Moreover, significant differences were found amongst the tested groups in linear deviations with less linear deviations in XYZ axes for SB compared to HA-SP group (P = 0.020, < 0.001, = 0.010 respectively). CONCLUSIONS: SB showed less angular and linear deviation values in the 3D positional transfer of TB than HA-SP indicating higher degree of accuracy of SB.

The precision of two alternative indirect workflows for digital model production: an illusion or a possibility?

OBJECTIVE: Despite the clear drive from both research and clinical dentistry toward digital transformation, there are limitations to implementing intra-oral scanning (IOS) into daily dental practice. This study aimed to compare the precision of digital models obtained from two alternative indirect workflows to direct IOS. MATERIAL AND METHODS: Two indirect digital workflows were evaluated in this study. In the IOS group (direct), IOS directly obtained digital impressions of participants' upper and lower dental arches, while in the Scan Impression (Scan Imp) group (indirect), a desktop scanner scanned silicone-based impressions of upper and lower whole arches that were taken with plastic trays. In the cone-beam computed tomography impression (CBCT Imp) group (indirect), a CBCT machine scanned the silicone-based impressions. Then, the precision of the entire arch and individual teeth for all digital impressions was virtually quantified. Following superimposition, differences between standard tessellation language (STL) files obtained from both-direct and indirect-methods were evaluated by color-mapping and measuring the surface distance between superimposed STL files. Furthermore, 18 linear measurements were taken from each digital model. ANOVA with repeated measures, Pearson coefficient, and intraclass correlation coefficient were used for intergroup comparisons. RESULTS: The digital models obtained from the two indirect workflows differed from the IOS in some dental and intra-arch measurements but were considered clinically acceptable. Ranked against IOS, CBCT Imp models had greater precision, followed by Scan Imp. CONCLUSION: Digital models obtained from two indirect, alternative workflows, desktop, and CBCT scanning of impression, have clinically acceptable accuracy and reliability of tooth size and intra-arch measurements, providing the use of proper methodologies. CLINICAL RELEVANCE: There are some limitations to implementing IOS in daily clinical practice. However, several alternative digital model production techniques might provide an affordable solution. Although they may insignificantly differ in accuracy, all can be applied clinically.

Outcomes of bio-esthetic single implant-supported restorations after peri-implant soft tissue conditioning with two prosthetic techniques: A 1-year randomized clinical trial.

STATEMENT OF PROBLEM: Providing a definitive restoration with an emergence profile matching that of the contralateral or extracted tooth should result in an esthetic peri-implant soft tissue contour. Whether a custom healing abutment improves the outcome of a bio-copied definitive restoration compared with a stock abutment is unclear. PURPOSE: The purpose of this 1-year randomized clinical trial was to evaluate the peri-implant soft and hard tissues related to bio-esthetic single implant-supported restorations having a contralateral tooth-matching restorative emergence profile after peri-implant soft tissue conditioning with either custom or stock healing abutment for patients indicated for immediate implant placement. MATERIAL AND METHODS: Twenty-four participants indicated for immediate implant placement in the maxillary esthetic zone received bio-esthetic single implant-supported restorations after peri-implant soft tissue conditioning with either a custom healing abutment (n=12) or a stock healing abutment (n=12). The pink and white esthetic score (PES-WES) was evaluated 6 and 12 months after implant placement. Peri-implant bone changes were measured with cone beam computed tomography (CBCT) scans at the same intervals. RESULTS: The PES-WES showed significant difference between the 2 groups at 6 and 12 months. The CBCT scans did not show significant difference between the 2 groups. CONCLUSIONS: The use of the bio-esthetic concept for immediate single implant placement achieved successful esthetic restorations after conditioning the peri-implant tissues using either custom or stock healing abutments. However, the use of custom healing abutments was associated with higher PES-WES values in comparison with the use of stock healing abutments.

CAD-CAM custom healing abutments: A dental technique.

Custom healing abutments are important in establishing optimal esthetics for prosthesis-driven, implant-supported restorations. This report demonstrates a technique for constructing a custom healing abutment with computer-aided design and computer-aided manufacturing to save chairside time and provide predictable results.

Periodontal changes following distraction osteogenesis in patients with cleft lip and palate: a clinical trial.

OBJECTIVES: To evaluate inflammatory mediator levels and periodontal changes following distraction osteogenesis (DO) in patients with cleft lip and palate (CLP) using mid-maxillary distraction (MMD). MATERIALS AND METHODS: A total of 20 healthy patients with CLP with Class III malocclusion were included. Segmental forward advancement of the anterior maxilla from the second premolars on both sides using DO was performed. A custom-made, tooth-borne distractor connecting buccal molar segments to the anterior maxilla was used for 7 days with 0.5-mm distraction for the first 2 days and then increased to 1 mm daily until overcorrection. Crevicular interleukin IL-1ß and tumor necrosis factor TNF-α levels were measured during distraction. Periodontal clinical parameters and indices were recorded at baseline and 3 and 6 months postoperatively. Soft tissue healing was evaluated histologically at 2 and 4 weeks after distraction. RESULTS: The periodontal parameters remained stable during the follow-up periods. Insignificant increases in the level of inflammatory cytokines compared with the control were observed. Histological findings revealed mild inflammatory and structural changes in the gingiva immediately after distraction, whereas regeneration was noticed after 4 weeks. CONCLUSIONS: MMD was an effective technique in treating patients with CLP, leading to new bone and soft tissue formation without significant detrimental effect on the periodontium of the adjacent teeth.

Fabrication of a CAD-CAM custom healing abutment guided by a conventional dental radiograph for delayed loaded dental implants: A dental technique.

This article describes a technique for fabricating a custom anatomic healing abutment for delayed loaded implants by using the computer-aided design and computer-aided manufacturing (CAD-CAM) technology from a polymethyl methacrylate (PMMA) blank. The dimensions of the custom healing abutment are measured from a conventional dental radiograph and diagnostic casts. The healing abutment is used in the second surgical stage to guide soft tissue healing. The resulting soft tissue contour guides the design of the mucosal part of the custom implant abutment.

Acceleration of Alveolar Ridge Augmentation Using a Low Dose of Recombinant Human Bone Morphogenetic Protein-2 Loaded on a Resorbable Bioactive Ceramic.

PURPOSE: The aim of the present study was to evaluate the effect of a porous silica-calcium phosphate composite (SCPC50) loaded with and without recombinant human bone morphogenetic protein-2 (rhBMP-2) on alveolar ridge augmentation in saddle-type defects. MATERIALS AND METHODS: Micro-granules of SCPC50 resorbable bioactive ceramic were coated with rhBMP-2 10 mg and then implanted into a saddle-type defect (12 × 7 mm) in a dog mandible and covered with a collagen membrane. Control groups included defects grafted with SCPC50 granules without rhBMP-2 and un-grafted defects. Bone healing was evaluated at 8 and 16 weeks using histologic and histomorphometric techniques. The increase in bone height and total defect fill were assessed for each specimen using the ImageJ 1.46 program. The release kinetics of rhBMP-2 was determined in vitro. The height of the bone in the grafted defects and the total defect fill were statistically analyzed. RESULTS: SCPC50 enhanced alveolar ridge augmentation as indicated by the increased vertical bone height, bone surface area, and bone volume after 16 weeks. SCPC50-rhBMP-2 provided a sustained release profile of a low effective dose (BMP-2 4.6 ± 1.34 pg/mL per hour) during the 1- to 21-day period. The slow rate of release of rhBMP-2 from SCPC50 accelerated synchronized complete bone regeneration and graft material resorption in 8 weeks. Successful rapid reconstruction of the alveolar ridge by SCPC50 and SCPC50-rhBMP-2 occurred without any adverse excessive bone formation, inflammation, or fluid-filled voids. CONCLUSIONS: Results of this study suggest that SCPC50 is an effective graft material to preserve the alveolar ridge after tooth extraction. Coating SCPC50-rhBMP-2 further accelerated bone regeneration and a considerable increase in vertical bone height. These findings make SCPC50 the primary choice as a carrier for rhBMP-2. SCPC50-rhBMP-2 can serve as an alternative to autologous bone grafting.